Deep Vein Thrombosis Of Upper Limbs Research Articles

Prothrombotic Disorders in a Cohort of 25 Patients Undergoing Transplantation: Investigation and Management Implications

BackgroundMany patients referred for intestinal transplantation have a history of thrombosis. We undertook an analysis of transplanted patients to describe the history and frequency of thrombosis, clinical course, and management strategies used. ResultsTwenty-five patients underwent transplantation of intestine containing blocks between 2007 and 2012; 20 of 25 are still alive. Five of 25 patients were transplanted with history of portomesenteric thrombosis, 6 of 25 had experienced loss of venous access due to thrombosis, and 6 of 25 had history of mesenteric ischemia. Pretransplantation, 16 of 25 patients were anticoagulated. Thrombophilia screens identified 3 of 16 patients who were JAK2 positive, 1 of 25 who had antithrombin deficiency, and 1 of 25 who had a factor V Leiden heterozygote. Post-transplantation, of all 16 patients who were anticoagulated pretransplantation and continued postoperatively, 1 of 16 infarcted their small bowel graft and 4 of 16 developed a further venous thrombosis despite anticoagulation. Of the 9 without a previous history of thrombosis, 1 had a pulmonary embolus more than a decade after transplantation and another had an upper limb deep vein thrombosis associated with a line. Both were then anticoagulated. Seven of 25 are not anticoagulated, although they are administered antiplatelet prophylaxis. Postoperative bleeding complications of anticoagulation occurred in 3 patients. After a subarachnoid hemorrhage in 1 of those 3 patients, anticoagulation was stopped. The other 2 patients bled during ileal biopsy, and both remain on low molecular weight heparin treatment. ConclusionThose with identifiable thrombophilic tendency and a history of venous or arterial thrombosis are considered to be at high risk for recurrent thrombosis. Those without such a history could be considered low risk. Our practice is to anticoagulate all high-risk individuals before and after transplantation and offer antiplatelet prophylaxis to low-risk patients as the risk of anticoagulation probably outweighs the risk of thrombosis for them. Early input from hematologists is vital in the management of high-risk patients, particularly those who thrombose when anticoagulated.

The Management of Acute Upper Limb Deep Vein Thrombosis

The Management of Acute Upper Limb Deep Vein Thrombosis

P-089 Upper limb deep vein thrombosis in pregnancy (ULDVT): Case report of 4 patients

P-089 Upper limb deep vein thrombosis in pregnancy (ULDVT): Case report of 4 patients

Upper limb deep vein thrombosis due to Langer's axillary arch

Langer's axillary arch is a recognized muscular anomaly characterized by an accessory muscular band crossing the axilla that rarely causes symptoms. We describe a patient who presented with an upper limb deep vein thrombosis caused by this aberrant muscle, which we believe is the first reported case. Axillary surgery with division of the aberrant muscle relieved upper limb venous obstruction in this patient.

Venous Thoracic Outlet Compression and the Paget-Schroetter Syndrome: A Review and Recommendations for Management

Paget Schroetter syndrome, or effort thrombosis of the axillosubclavian venous system, is distinct from other forms of upper limb deep vein thrombosis. It occurs in younger patients and often is secondary to competitive sport, music, or strenuous occupation. If untreated, there is a higher incidence of disabling venous hypertension than was previously appreciated. Anticoagulation alone or in combination with thrombolysis leads to a high rate of rethrombosis. We have established a multidisciplinary protocol over 15years, based on careful patient selection and a combination of lysis, decompressive surgery, and postoperative percutaneous venoplasty. During the past 10years, a total of 232 decompression procedures have been performed. This article reviews the literature and presents the Exeter Protocol along with practical recommendations for management.

FV Leiden, FII G20210A and MTHFR C677T mutations in patients with lower or upper limb deep vein thrombosis

Deep vein thrombosis (DVT) is a multifactorial disease that occurs with frequency of 1/1000 per year. The FV Leiden, FII G20210A and MTHFR C677T mutations represent genetic factors for the occurrence of vein thrombosis. The goal of this study was to determine the frequency of these mutations in patients with DVT of upper and lower limbs. The study encompassed 119 patients divided in two groups. The group of patients with the lower limbs thrombosis included 77 patients, while the upper limbs thrombosis group included 42 patients. The presence of FV Leiden, FII G20210A and MTHFR C677T mutations was detected by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis. In patients with DVT of lower limbs, the frequency of FV Leiden mutation was 26,0% in heterozygous form and 1,3% in homozygous form. In the group of patients with DVT of upper limbs, the frequency of heterozygous carriers was 7.2%. In patients with DVT of lower limbs, FII G20210A mutation occurred in heterozygous form in 15.6% subjects, and in the group with DVT of upper limbs the frequency was 7.2% in heterozygous and 2.3% in homozygous form. The frequency of MTHFR C677T mutation in patients with lower limbs DVT was 42.8% in heterozygous form and 13% in homozygous form, while in the group of patients with upper limbs DVT, the frequency was 52.4% in heterozygous form and 9.5% in homozygous form. The FV Leiden and FII G20210A mutations represent significant risk factors for the occurrence of DVT of lower limbs. These mutations are less frequent in DVT of upper limbs and more extensive further studies are needed to determine their potential role. The MTHFR C677T mutation represents less significant risk factor for lower limb DVT and should be taken into account only in cases when it occurs in combination with other risk factors.

Upper limb deep vein thrombosis: a potentially fatal complication of a clavicle fracture

We present a case a 48-year-old man who was diagnosed with an upper limb deep vein thrombosis post clavicle fracture. He was successfully investigated with a computed tomography (CT) venogram, thrombophilia was excluded, and he was subsequently treated with a 3-month course of anticoagulation. We illustrate this case with photographs and a three-dimensional colour reconstruction of a CT venogram to raise awareness of the condition. A suitable level of clinical suspicion should be maintained by the orthopaedic surgeon; delayed arm swelling with venous congestion following a clavicle fracture should be investigated with CT venography and thrombophilia should be excluded.

Prophylaxis of catheter-related thrombosis in cancer patients

Long-term central venous catheters have greatly improved the management of patients with cancer. However, their use has been associated with upper-limb deep-vein thrombosis (DVT), especially in those patients who need chemotherapy.1 The true incidence of upper-limb DVT in patients with central venous lines is difficult to estimate, because published data are conflicting. When thromboprophylaxis was not used, Bern and colleagues2 found an incidence of 37%, as shown by phlebography. Monreal and co-workers3 reported an even higher incidence.

Risk and prophylaxis of catheter-related venous thromboembolism after cardiac surgery: where is the evidence?

SIMI 2008 The use of central venous catheters (CVC) is becoming increasingly frequent in medical and surgical patients, particularly for measurement of hemodynamic variables, administration of drugs, hemoderivatives, total parenteral nutrition and hemodialysis [1]. Unfortunately, the advantages secured by the extensive use of CVCs are associated with an increased risk of upper limb deep vein thrombosis (DVT) [2]. Several genetic and acquired risk factors may increase the risk of development of upper limb DVT in patients with CVC, such as malignancy, infections, thrombophilia, surgery, plaster cast and oral contraceptive use. Moreover, the risk of thrombosis is also dependent on specific characteristics of the catheters (e.g., diameter, material, type and side of insertion, misplacement of the tip). The clinical signs of CVC-related thrombosis include upper extremity DVT, pulmonary embolism (PE), malfunctioning of the CVC, and infection [3]; however, it should be noted that very fre

Should cancer patients receive thromboprophylaxis to prevent catheter-related upper limb deep vein thrombosis?

Should cancer patients receive thromboprophylaxis to prevent catheter-related upper limb deep vein thrombosis?

Risk factors for upper limb deep vein thrombosis associated with the use of central vein catheter in cancer patients

Deep vein thrombosis of upper limb is a common complication of CVC in patients with cancer. In these patients the risk factors for CVC-related thrombosis are not completely defined. The purpose of this study was to identify the risk factors for CVC-related thrombosis in patients included in a randomized, double-blind, placebo-controlled study aimed at assessing the efficacy and safety of enoxaparin for the prophylaxis of CVC-related thrombosis. CVC-related thrombosis was screened by mandatory venography after 6 weeks of study treatment. A number of patient baseline characteristics were assessed as potential risk factors for CVC-related deep vein thrombosis. Crude associations between risk factors and clinical outcomes were assessed by chi(2) test or Fisher's exact test. Multiple logistic regression analysis was used to identify independent risk factors. A CVC-related thrombosis was found in 50 out of 310 patients (16.1%). At multiple logistic regression analysis, CVC tip misplaced in the upper half of superior vena cava (OR 4.05, 95%CI 1.64-10.02), left-sided CVC insertion (OR 2.29, 95%CI 1.01-5.51) and chest radiotherapy (OR 7.01, 95%CI 1.42-34.66) were independent risk factors for thrombosis. In addition to these risk factors, the presence of distant metastases (OR 9.36, 95%CI 1.53-57.05) increased the risk of thrombosis in patients who received placebo. An inadequate position of the CVC tip, left-sided CVC insertion and chest radiotherapy are independent risk factors for CVC-related thrombosis in cancer patients. Patients with distant metastases have an increased risk for thrombosis in absence of antithrombotic prophylaxis.

Clinical characteristics and management of cancer-associated acute venous thromboembolism: findings from the MASTER Registry

Clinical characteristics and management of acute deep vein thrombosis and pulmonary embolism (PE) have been reported to be different in patients with and without cancer. The aim of this paper was to provide information on clinical characteristics and management of acute venous thromboembolism in patients with cancer by means of a large prospective registry. MASTER is a multicenter registry of consecutively recruited patients with symptomatic, objectively confirmed, acute venous thromboembolism. Information about clinical characteristics and management was collected by an electronic data network at the time of the index event. A total of 2119 patients were enrolled, of whom 424 (20%) had cancer. The incidence of bilateral lower limb deep vein thrombosis was significantly higher in patients with cancer than in patients without cancer (8.5% versus 4.6%; p<0.01), as were the rates of iliocaval thrombosis (22.6% versus 14%; p<0.001), and upper limb deep vein thrombosis (9.9% versus 4.8%; p<0.001). Major bleeding (3.3% versus 1.1%; p=0.001), in-hospital treatment (73.3% versus 66.6%; p=0.02) and inferior vena cava filter implantation (7.3% versus 4.1%; p=0.005) were significantly more frequent in patients with cancer, in whom oral anticoagulants were less often used (64.2% versus 82%; p<0.0001). The clinical presentation of acute venous thromboembolism is different and often more extensive in cancer patients than in patients free from malignancy. Moreover, the management of the acute phase of venous thromboembolism is more problematic in cancer patients, especially because of a higher rate of major bleeding and the need for implantation of inferior vena cava filters.

Prophylaxis of upper limb deep vein thrombosis in cancer patients with central vein catheter

Prophylaxis of upper limb deep vein thrombosis in cancer patients with central vein catheter -

Therapy Insight: venous-catheter-related thrombosis in cancer patients

Central venous catheters (CVCs) have improved the management of patients with cancer substantially, by facilitating chemotherapy and supportive therapy. The use of CVCs is associated with complications such as infection and upper-limb deep vein thrombosis (UL-DVT). The incidence of clinically overt UL-DVT related to the use of CVCs ranges between 2% and 4%. In the most recent study, the incidence of CVC-related thrombosis, as screened by venography, was approximately 18% in the absence of prophylaxis. In cancer patients with CVC-related UL-DVT, the incidence of clinically overt pulmonary embolism was between 15% and 25%, and the incidence of autopsy-proven pulmonary embolism was up to 50%. Pathogenic factors for CVC-related thrombosis include vessel injury caused by the CVC insertion procedure, venous stasis because of the indwelling CVC, and hypercoagulability associated with cancer. Recent studies have not confirmed a benefit for prophylaxis with antithrombotic agents for CVC-related thrombosis. The recommended treatment for CVC-related thrombosis is based on long-term anticoagulant therapy, with or without catheter removal.

A double-blind placebo-controlled randomized study on the efficacy and safety of enoxaparin for the prevention of upper limb deep vein thrombosis in cancer patients with central vein catheter

8021 Background: Efficacy of prophylaxis with fixed dose of warfarin or low molecular weight heparin (LMWH) for upper limb deep vein thrombosis (UL-DVT) related to central vein catheter (CVC) has been claimed after open studies with limited sample size. The rate of bleeding in cancer patients receiving prolonged prophylaxis with LMWH is unclear. The aim of this study was to evaluate the efficacy and safety of the LMWH enoxaparin in the prevention of UL-DVT in cancer patients with CVC. Methods: Consecutive cancer patients with CVC for chemotherapy were included in a multicenter double-blind randomized placebo-controlled study performed in 11 Italian centers. Enoxaparin, 40 mg once a day, or placebo were given subcutaneously for 6 weeks, starting 2 hours before the CVC insertion. The primary endpoint of the study was UL-DVT, as detected by venography (CVC limb) performed at 6 weeks and/or clinically overt pulmonary embolism confirmed by objective testing. The secondary endpoints of the study were death from thromboembolic disease and death from any cause at 3-month. The safety endpoint was major bleeding. Results: 385 patients were included in the study. 321 patients underwent venography (83.4%). The primary efficacy outcome was assessed in 310 patients with adequate venography. Enoxaparin reduced the incidence of UL-DVT from 18.1 % (28/155) to 14.2 % (22/155), a relative risk reduction of 21.4 % (95% CI: 0.47 to 1.31, p=0.35). Two patients in the enoxaparin group (1.0%) and 6 patients in the placebo group (3.1%) had a symptomatic venous thromboembolism. No major bleeding occurred in both treatment groups. Minor bleeding occurred in 6.3% of the patients (12/191) in the enoxaparin group and 3.6% of the patients (7/194) in the placebo group. Conclusions: Enoxaparin, at the dose of 40 mg daily, produced a 21% non significant reduction in the incidence of CVC-related DVT in cancer patients. This dose was safe and well tolerated: this leaves open the option of increasing the dose of enoxaparin to optimize its efficacy in this clinical setting. No significant financial relationships to disclose.

A double-blind placebo-controlled randomized study on the efficacy and safety of enoxaparin for the prevention of upper limb deep vein thrombosis in cancer patients with central vein catheter

8021 Background: Efficacy of prophylaxis with fixed dose of warfarin or low molecular weight heparin (LMWH) for upper limb deep vein thrombosis (UL-DVT) related to central vein catheter (CVC) has been claimed after open studies with limited sample size. The rate of bleeding in cancer patients receiving prolonged prophylaxis with LMWH is unclear. The aim of this study was to evaluate the efficacy and safety of the LMWH enoxaparin in the prevention of UL-DVT in cancer patients with CVC. Methods: Consecutive cancer patients with CVC for chemotherapy were included in a multicenter double-blind randomized placebo-controlled study performed in 11 Italian centers. Enoxaparin, 40 mg once a day, or placebo were given subcutaneously for 6 weeks, starting 2 hours before the CVC insertion. The primary endpoint of the study was UL-DVT, as detected by venography (CVC limb) performed at 6 weeks and/or clinically overt pulmonary embolism confirmed by objective testing. The secondary endpoints of the study were death from thromboembolic disease and death from any cause at 3-month. The safety endpoint was major bleeding. Results: 385 patients were included in the study. 321 patients underwent venography (83.4%). The primary efficacy outcome was assessed in 310 patients with adequate venography. Enoxaparin reduced the incidence of UL-DVT from 18.1 % (28/155) to 14.2 % (22/155), a relative risk reduction of 21.4 % (95% CI: 0.47 to 1.31, p=0.35). Two patients in the enoxaparin group (1.0%) and 6 patients in the placebo group (3.1%) had a symptomatic venous thromboembolism. No major bleeding occurred in both treatment groups. Minor bleeding occurred in 6.3% of the patients (12/191) in the enoxaparin group and 3.6% of the patients (7/194) in the placebo group. Conclusions: Enoxaparin, at the dose of 40 mg daily, produced a 21% non significant reduction in the incidence of CVC-related DVT in cancer patients. This dose was safe and well tolerated: this leaves open the option of increasing the dose of enoxaparin to optimize its efficacy in this clinical setting. No significant financial relationships to disclose.

A Case of Legionnaires' Disease with Extensive Concurrent Deep Vein Thrombosis

A previously healthy 37-y-old male presented with community-acquired pneumonia and extensive upper limb deep vein thrombosis. The diagnosis of Legionella pneumonia was made based on a positive direct immunofluorescence of the bronchial wash. An extensive investigation for hypercoagulable states was negative. The possible association between Legionella infection and deep vein thrombosis is highlighted.

Risk Factors and Management of Patients With Upper Limb Deep Vein Thrombosis

To determine the prevalence of endogenous and exogenous risk factors for venous thrombosis in patients with upper limb deep vein thrombosis (DVT), and to evaluate the risk of clinically detectable pulmonary embolus, recurrent DVT, and postphlebitic symptoms in these patients. A combined prospective and retrospective descriptive analysis of a cohort of patients with upper limb DVT compared with age- and sex-matched patients with lower limb DVT. Internal medicine departments, and hematology and vascular surgery outpatient clinics at a tertiary-care university hospital. Consecutive patients with "spontaneous" upper limb DVT diagnosed between 1989 and 1997 were studied. Twenty age- and sex-matched patients with lower limb DVT admitted to the hospital via the emergency department served as control patients. Eighteen patients with upper limb DVT were studied. An endogenous risk factor (thrombophilia) was present in 11 of 18 patients vs 8 of 20 control patients (p = not significant). In the upper limb group, nine patients had activated protein C resistance, four patients had anticardiolipin antibodies, and two patients had both forms of thrombophilia. Furthermore, 14 of the upper limb DVT patients were found to have an exogenous risk factor for thrombosis compared with 7 of the patients with lower limb DVT (p = 0.01), and 66.6% of patients with upper limb DVT had both an exogenous and an endogenous risk factor for thrombosis vs 15% of patients with lower limb DVT (p < 0.002). No clinically detectable pulmonary emboli occurred among the upper limb DVT patients. Three patients have minor postphlebitic symptoms. Two patients experienced recurrent DVT. In the majority of patients with upper limb DVT that we studied in this relatively small study, exogenous (environmental) or endogenous risk factors for venous thrombosis, or a combination of both, were found. Furthermore, in our patients, these thromboses had a low propensity to cause clinically significant pulmonary embolus and did not cause significant postphlebitic symptoms. Finally, we suggest that anticoagulant therapy for these thromboses may be adequate and that thrombolytic agents and surgical intervention are not routinely indicated.

Risk Factors and Management of Patients With Upper Limb Deep Vein Thrombosis.

Risk Factors and Management of Patients With Upper Limb Deep Vein Thrombosis.